Frequently Asked Questions About GERD
For people with conditions affecting the esophagus (the tube that connects your mouth to your stomach), simply eating a meal can trigger uncomfortable symptoms. Here are some answers to some more frequently asked questions about GERD:
Questions about GERD
- How can I manage my GERD symptoms?
- Is coughing a common symptom of GERD?
- How can I best prepare for a GERD attack?
- How is someone diagnosed with GERD?
- Do I actually have GERD?
Questions about Esophageal Cancer
- Are there any symptoms of cancer that are not present with ordinary GERD?
- I think I may have esophagus cancer. What’s a good indicator?
Questions about GI Tests
- What does an upper GI test reveal?
- Will my doctor be able to see if I have Barret’s esophagus while performing an upper GI test?
- What is intestinal metaplasia?
- Why else may I have an upper GI test performed?
Questions about Treatments
- What testing should I have done if I think I have significant gastrointestinal bleeding?
- What are the long-term effects of using PPIs?
- When should I consider surgery?
- What is the long-term prognosis with reflux esophagitis?
How can I manage my GERD symptoms?
You can manage GERD symptoms by using:
- H2 blockers (Tagamet or Pepcid)
- Acid suppressors (Prilosec or Prevacid)
- Prokinetic agents (Propulsid)
- Other medicines used to relieve less common symptoms (Rectiv and Procardia)
There are other measures that you can initiate to reduce the symptoms of GERD:
- Elevate the head of your bed 10-15 degrees to prevent stomach contents from refluxing into the esophagus.
- Avoid eating at least two hours before going to bed.
- Avoid foods that may worsen symptoms such as alcohol, caffeine, chocolate and peppermint products.
For a more comprehensive list of how to maintain your specific symptoms, please consult a member of our GERD team.
Is coughing a common symptom of GERD?
Coughing is a common symptom of GERD, and there may be several reasons for it:
- Acid may be refluxing into the mouth and is being sucked into the lungs.
- There may be a nerve reflex started by acid refluxing into the esophagus. The acid causes spasm of the air tubes, which can lead to a dry cough.
- If you have had chronic reflux, you may develop a stricture, or narrowing of the esophagus. Food may regurgitate and be aspirated, causing a coughing/choking sensation.
- If you smoke, your reflux can get worse and cigarettes could be responsible for the cough.
How can I best prepare for a GERD attack?
Symptomatic esophageal reflux is a reoccurring problem. Once the symptoms recur, there is nothing to do but wait for the antacids to stop acid production so that the esophagus can heal. There are lifestyle modifications that can help control these symptoms:
- Eating three meals a day
- Avoiding coffee, alcohol, cigarettes and fatty foods
- Not lying down for three hours after eating
When you have symptoms, you can obtain relief with antacids or over-the-counter H2 blockers like Tagamet, Pepcid AC, etc.
Attacks prevention often requires pharmacologic doses of H2 blockers or proton-pump inhibitors such as Prevacid or Prilosec. Prokinetic agents, such as Propulsid, are often used to prevent reflux symptoms.
How is someone diagnosed with GERD?
GERD is an abbreviation for gastroesophageal reflux disease. This condition is characterized by reflux of acidic stomach contents into the esophagus causing irritation and in some patients, pain. The presentation of this disease is very diverse.
Do I actually have GERD?
Before you can say that your condition is GERD, other possibilities need to be considered. For example, the following problems can present with symptoms similar to GERD:
- Gastritis (inflammation of the stomach lining)
- Infectious esophagitis
- Pill esophagitis
- Peptic ulcer disease
- Dyspepsia (recurring pain or discomfort centered in the upper abdomen)
- Biliary tract disease
- Coronary artery disease
- Esophageal motor disorders
If your symptoms are severe, your doctor may recommend that you talk to our GERD team. If necessary, an endoscopic exam using a flexible scope can be performed to evaluate your upper gastrointestinal tract (consisting of the esophagus, stomach and the first portion of small bowel).
If this is negative, an ultrasound of the abdomen to evaluate the biliary tract may be considered. A gastroenterologist may recommend further studies.
Are there any symptoms of cancer that are not present with ordinary GERD?
Cough is an atypical manifestation of GERD. It may be associated with hoarseness or dental problems if caused by GERD. Having a cough does not necessary imply that you have Barrett's esophagus or esophageal cancer.
I think I may have esophagus cancer. What’s a good indicator?
Esophageal cancer is generally suspected in patients (especially in those over age 45) with long-term GERD who are: Losing weight Have difficulty swallowing Have evidence of gastrointestinal bleeding. A relationship between chronic hoarseness, GERD, vocal cord polyps and throat cancer has been reported.
What does an upper GI test reveal?
An upper GI series is a good test to look for strictures, masses or diverticula. It is not as good at detecting mild forms of esophagitis (inflammation of the esophagus).
Will my doctor be able to see if I have Barret’s esophagus while performing an upper GI test?
It is very hard to tell if a patient has Barrett's esophagus based solely on an upper GI series. Barrett's esophagus is a complication of longstanding GERD. It is a microscopic tissue diagnosis that is usually made after studying specimens taken during an upper GI endoscopy. Esophageal biopsy specimens that show intestinal metaplasia (anchor to below questions) warrant further surveillance endoscopies.
What is intestinal metaplasia?
Intestinal metaplasia is a change in the lining of the lower esophagus, making it more consistent with lining of the small intestine.
Why else may I have an upper GI test performed?
It may be necessary to perform an endoscopy to look for inflammation of the lining of the esophagus and to biopsy the esophagus as needed. If you continue to have symptoms of GERD, despite treatment and a normal x-ray, you may benefit from dietary measures called 'anti-reflux measures.' Your doctor may also want to try some medications to help treat GERD.
What testing should I have done if I think I have significant gastrointestinal bleeding?
A rectal examination to test for microscopic blood in your stool should be done if this is a concern, especially if you use more than one adult strength aspirin a day on a regular basis (or aspirin-like products such as Advil, Motrin, etc.). Aspirin products can cause irritation of the stomach lining and even ulcers that can result in bleeding.
What are the long-term effects of using PPIs?
Proton pump inhibitors (PPIs) include omeprazole (Prilosec) and lansoprazole (Prevacid). When first introduced, Prilosec was only approved for short periods because of the possibility of developing rare stomach tumors called carcinoids due to prolonged acid suppression.
However, Prilosec has since been used in Europe on patients with ulcers and GERD for several years at a time without adverse effects. Therefore, it is currently prescribed in the United States for prolonged periods.
In clinical practice, we try to use lowest dose of Prilosec or Prevacid necessary to control symptoms and try to wean patients off the drugs whenever possible. On the other hand, we will prescribe these medications for longer periods as necessary if clinically warranted.
When should I consider surgery?
If you do not obtain relief with Prevacid, you might want to consider surgery. You should undergo further testing prior to surgery to confirm the diagnosis of GERD and to rule out other esophageal motility disorders. You should also be aware that any surgical procedure has associated risks. It is important to consider the risks, benefits and alternatives of any procedure prior to proceeding with surgery.
What is the long-term prognosis with reflux esophagitis?
Reflux esophagitis (inflammation of the esophagus due to acid entering the esophagus) is a chronic condition. The severity of symptoms can vary but most people will have intermittent discomfort or ongoing problems. It is unusual to have only one episode of symptoms.
If you have any other questions or concerns, please consult a Henry Ford gastroenterologist.